We reviewed cerebrospinal fluid (CSF) shunt infections treated in the
Royal Children's Hospital, Melbourne from 1981 to 1991. Forty-one epis
odes of CSF shunt infection were found after 900 shunt operations, an
infection rate of 4.5%, Clinical symptoms were nonspecific in 31.7% of
episodes, and in 17.1% of episodes the initial CSF sample was normal
on microscopy and biochemistry, although a pathogen was isolated on cu
lture, Most episodes occurred within 4 months of the last operation on
the shunt, the exception being infections caused by Haemophilus influ
enzae, Four patients died during treatment, but none could be attribut
ed to infection alone, Treatment of suspected CSF shunt infection shou
ld not be withheld because of lack of firm clinical diagnosis or norma
l CSF microscopy, and episodes occurring more than 4 months after the
last operation on the CSF shunt should receive antibiotic cover for H.
influenzae.